Primary Nodal Unclassifiable CD20 Negative Diffuse Large B-cell Lymphoma With Dual IgK and TCR Gene Rearrangement: A Diagnostic Challenge

Author:

Hadžisejdić Ita12,Klarica Lucia2,Babarović Emina12,Marijić Blažen34,Valković Toni56,Jonjić Nives12

Affiliation:

1. Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia

2. Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

3. Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia

4. Department of Otorhinolaryngology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

5. Department of Haematology, Clinical Hospital Center Rijeka, Rijeka, Croatia

6. Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

Abstract

Non-Hodgkin lymphomas are most frequently classified based on the lineage marker expression. However, lymphomas with aberrant marker expression as well as monoclonal IgH/IgΚ and TCR gene rearrangements may co-exist which can be misleading and confusing. Primary CD20 negative diffuse large B-cell lymphomas (DLBCL) represent a rare entity, and they account for 1% to 3% of cases. However, some CD20 negative DLBCLs could not be classified into known variants, creating both diagnostic and therapeutic dilemma’s. Primary CD20 negative DLBCL are more likely to have a non-germinal centre subtype, a higher proliferation index, more frequent extra-nodal involvement, a poorer response, and poorer prognosis to conventional treatment compared to CD20 positive DLBCL. A 66- year-old postmenopausal lady, presented with palpable, bilateral neck lymphadenopathy and difficulty swallowing. She also had left leg lymphoedema, poor appetited, fatigue and weight loss. Her symptoms lasted approximately 1 month. After histological, immunohistochemical and clonality analysis of the lymph node the patient was diagnosed with primary nodal CD20 and PAX-5 negative DLBCL with dual immunoglobulin light-chain kappa ( IgK) and T-cell receptor ( TCR) gene rearrangement. This unusual and unique case presented a diagnostic challenge because it was CD20 and PAX-5 negative, had dual IgK and TCR gene rearrangement and, it could not be classified within the known and well established CD20 negative DLBCL variants. Describing such cases emphasises the fact that lymphomas unclassifiable within known variants of CD20 negative DLBCL do exist and that range and heterogeneity of CD20 negative DLBCL continues to evolve, and pathologist should be aware of these uncommon, atypical mature B-cell neoplasms.

Publisher

SAGE Publications

Subject

Microbiology (medical),Histology,Pathology and Forensic Medicine

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